Consent

 
20% of survey complete.

Consent to securely transmit and store personal health information

This form collects and stores Personal Health Information.  All information is sent and stored in encrypted format.  Our technology vendor has signed a HIPPA Business Associate contract to ensure they comply with all HIPPA rules to protect your health information.

Please review our HIPPA Security Policy at Specialty Natural Medicine by clicking here for more information on how your personal health information is protected.

* 1. Do you consent to have your New Patient information securely transmitted and stored with Specialty Natural Medicine and our HIPPA compliant technology vendors?

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